Abstract The vision of taking a more market-oriented approach to dissemination likely raises more questions than it answers. Who would build and operate such a system? Who would pay for it? Would researchers who have developed and evaluated public health interventions cooperate in sharing their programs and products? What tangible incentives can be created at each step of the process to encourage dissemination and adoption? What would constitute success for such an effort and how would we measure it? All are important questions and worthy of thoughtful answers that match their complexity. Doing so is beyond the scope of this chapter, but ongoing in our work. It is hoped the ideas presented here will stimulate others’ thinking about systems and infrastructure to enhance dissemination and welcome critiques, refinement, and additions to the proposed model.

Objectives: Nonpharmacologic pain management strategies are needed because of the growing opioid epidemic. While studies have examined the efficacy of virtual reality (VR) for pain reduction, there is little research in adult inpatient settings, and no studies comparing the relative efficacy of standard animated computer-generated imagery (CGI) VR to Video Capture VR (360 degrees 3D/stereoscopic Video Capture VR). Here, we report on a randomized controlled trial of the relative efficacy of standard CGI VR versus Video Capture VR (matched for content) and also compared the overall efficacy of VR to a waitlist control group. Materials and Methods: Participants (N=103 hospitalized inpatients reporting pain) were randomized to 1 of 3 conditions: (1) waitlist control, (2) CGI VR, or (3) Video Capture VR. The VR and waitlist conditions were 10 minutes in length. Outcomes were assessed pretreatment, post-treatment, and after a brief follow-up. Results: Consistent with hypotheses, both VR conditions reduced pain significantly more relative to the waitlist control condition (d=1.60, P<0.001) and pain reductions were largely maintained at the brief follow-up assessment. Both VR conditions reduced pain by ∼50% and led to improvements in mood, anxiety, and relaxation. Contrary to prediction, the Video Capture VR condition was not significantly more effective at reducing pain relative to the CGI VR condition (d=0.25, P=0.216). However, as expected, patients randomized to the Video Capture VR rated their experience as more positive and realistic (d=0.78, P=0.002). Discussion: Video Capture VR was as effective as CGI VR for pain reduction and was rated as more realistic.

Aging adults experience a disproportionate number of health-related problems. We applied a technological capital framework to assess how participation in web-delivered interventions is influenced by resources, perceived support, technology skills, and an overall environment conducive to making a change. Specifically, we conducted an in-depth examination of the uses and attitudes regarding online health information technologies among 41 middle-aged and older adults ('digital immigrants'). Situated in a six-year community ethnography, this qualitative study identifies potential barriers confronting middle-aged and older adults' engagement with online interventions and extends existing work on the four factors comprising technological capital (awareness, knowledge, access, and technological capacity). We found six major themes related to ICT use: literacy, comfort, adoption willingness, infrastructure, information security, and support availability. We provide evidence-based recommendations for overcoming barriers, and recommendations for assessing and teaching information technology skills across the lifespan without being ageist.

To observe students' reactions to an emergency and how they use social media to communicate about it shortly after, this content analysis examines social media posts directly after a deadly stabbing that took place on The University of Texas at Austin campus in the Spring of 2017. A text-mining approach was used to analyze a total of 17,216 tweets and retweets posted within 48-hours after the attack. Approximately half of the tweets were news reports of the event, the remainder depicted unique reactions to the circumstances surrounding the stabbing. The most recurring topics to emerge were status updates on the situation, expressions of distrust for the mainstream media, theories about the motivation behind the attack, and inflammatory rumors of additional violent incidents nearby campus. The most influential Twitter profiles were operated by mainstream news outlets and included no official city or campus accounts. Now that individuals can access information online before officials even formulate a response, monitoring and leveraging social media sites like Twitter before and during an emergency can help identify and reduce the spread of misinformation. As social and mobile media continue to penetrate college campuses, we must examine how the dissemination of information shapes fact and fiction.

Higher education institutions face profound communication challenges managing risks for university communities during the ongoing pandemic. This commentary shares 1) findings from our study involving analysis of 17 focus groups of students, faculty, staff, and parents of students to explore effective COVID-19 messages about campus safety, and 2) insights into the process of integrating the expertise of a university health communication center into campus-wide responses to COVID-19. Key focus group takeaways highlight the importance of communicating empathetically, acknowledging those who are made vulnerable through their work on campus, and that promises to return to normal would be perceived as unrealistic. Bringing the evidence base of health communication to the typical work of professional communicators on campus allowed us to create a communication toolkit for consistent messaging, and in turn, learn about the vital role health communication scholars can play in university crisis messaging.

Given the role opioid overprescribing has played in the current overdose crisis, reducing the supply of prescription opioids available for misuse has gained widespread support. Prescription monitoring programs (PMPs) have been identified as a tool for achieving this goal, but little is known about how to promote PMP use to prescribers. This paper describes the process of developing a health communication campaign to support the adoption of the Texas PMP. After formative research, message development and concept testing, a range of campaign concepts and messages were tested and final recommendations determined. The messages and lessons learned have utility beyond Texas.

Background Fathers make unique and central contributions to the health of their children. However, research in type 1 diabetes (T1D) education largely ignores the needs of fathers, including during the development of online and mobile educational materials. Objective The purpose of this study was to solicit and incorporate input from fathers of children with T1D into the design, content, and infrastructure of a suite of online diabetes self-management education and support (DSMES) resources. Methods The study took part in three phases: (1) exploratory research, (2) website and subdomain development, and (3) evaluation. Fathers of children with T1D (n=30) completed surveys and semistructured qualitative interviews. Thematic content analysis was used to identify fathers’ content and design preferences. An online DSMES website (T1DToolkit.org) and a separate mobile subdomain targeting fathers (Mobile Diabetes Advice for Dads, or mDAD) were developed. A prototype of the site for fathers was evaluated by 33 additional father participants. End user feedback was elicited via survey. Results Participants in the exploratory phase were enthusiastic about the online diabetes resources. Preferences included high-quality design, availability via mobile phone and tablet, brief text content supplemented with multimedia and interactive features, reminders via text or email, endorsement by medical professionals, and links to scientific evidence. The mDAD subdomain received high usability and acceptability ratings, with 100% of participants very likely or likely to use the site again. Conclusions The development of eHealth educational platforms for fathers of children with T1D remains an unmet need in optimizing diabetes management. This study incorporated fathers’ feedback into the development of a suite of online diabetes education resources. The findings will serve as the basis for future research to assess the clinical efficacy of the website, its subdomain targeting fathers, and additional subdomains targeting unique populations.

This study used the regulatory focus/fit framework to compare the impact of text message wording on college students’ drinking behaviors. In this 2 × 3 × 2 pre-test/post-test experiment, participants ( N = 279) were randomly assigned to one of the three groups: messages matching regulatory focus (congruent group), messages mismatching regulatory focus (incongruent group), and general health messages (control group). Messages were tailored by regulatory fit (prevention-oriented or promotion-oriented). Mixed factorial analyses of covariance revealed that prevention-oriented individuals who received text messages incongruent with their regulatory focus reported drinking alcohol for more hours and were more likely to consume a higher quantity of drinks than participants in the congruent or control group. These findings suggest that health messages mismatched to a receiver’s regulatory focus might exacerbate unhealthy behavior.

Objective: Text-messaging interventions positively affect health behaviors, but their use on college campuses has been limited. Text messaging serves as a relatively affordable way to communicate with large audiences and is one of the preferred modes of communication for young adults. This study examined the feasibility and acceptability of a campus-wide, health text–messaging program. Participants: The subscriber pool consisted of approximately 6,000 undergraduate students from a large, southern university. From that pool, 1,095 participants (64% female; 41% White) completed a posttest survey. Method: Text messages covered a range of health topics and information about campus resources. Research was conducted from August through December 2015. Process data were collected throughout the semester; participants’ attitudes were assessed via an online survey at the program’s conclusion. Results: Students demonstrated engagement with the messages throughout the semester as evidenced by replies to text-back keywords and clicks on website links embedded within messages. Messages about sleep, stress management, and hydration were considered most relevant. The majority of participants (61%) reported increased awareness regarding their health. Conclusions: Text-messaging interventions are a feasible strategy to improve college student health.

Health communication faculty face increasing expectations regarding their academic productivity, including the expectation to seek and secure external funding. Doctoral training in health communication that does not fully prepare students for the challenges of securing external funding is doing them a disservice that will make them less competitive for academic positions and less likely to succeed in the academic positions they assume. The purpose of this study is to share the evaluation of a program, the Health Communication Scholars Program (HCSP), designed to train future health communication researchers in the pursuit of external funding. The HCSP includes a grant-writing workshop, requires interdisciplinary graduate student teams to submit applications, and awards funding to top proposals. HCSP participants responding to an evaluation survey (N=25) had overwhelmingly positive experiences; respondents felt the program provided great value, improved their writing skills, gave them skills to pursue funding in the future, and helped them secure tenure-track faculty positions. The results of this formal evaluation suggest the HCSP is an experience that builds crucial skills and prepares graduate students for the demands they will face as faculty. It is a relatively low-cost, replicable model that merits consideration and adoption at other institutions that hope to provide professional development for doctoral students interested in health communication.

Despite widespread understanding of the benefits of physical activity, many adults in the United States do not meet recommended exercise guidelines. Burgeoning technologies, including wearable fitness trackers (e.g., Fitbit, Apple watch), bring new opportunities to influence physical activity by encouraging users to track and share physical activity data and compete against their peers. However, research has not explored the social processes that mediate the relationship between the use of wearable fitness trackers and intention to exercise. In this study, we applied the Theory of Planned Behavior (Ajzen, 1991) to explore the effects of two communicative features of wearable fitness devices-social sharing and social competing-on individuals' intention to exercise. Drawing upon surveys from 238 wearable fitness tracker users, we found that the relationship between the two communication features (social sharing and competing) and exercise intention was mediated by attitudes, subjective norms, and perceived behavioral control. The results suggest that the ways in which exercise data are shared significantly influence the exercise intentions, and these intentions are mediated by individuals' evaluation of exercise, belief about important others' approval of exercise, and perceived control upon exercise.

The authors realize that the vision of taking a more market-oriented approach to dissemination likely raises more questions than it answers. Who would build and operate such a system? Who would pay for it? Would researchers who have developed and evaluated public health interventions cooperate in sharing their programs and products? What tangible incentives can be created at each step of the process to encourage dissemination and adoption? What would constitute success for such an effort and how would we measure it? All are important questions and worthy of thoughtful answers that match their complexity. Doing so is beyond the scope of this chapter, but ongoing in our work. The authors hope the ideas presented here will stimulate others’ thinking about systems and infrastructure to enhance dissemination, and welcome critiques, refinement, and additions to our proposed model.

Context: The first imported US Ebola hemorrhagic fever case during the 2014 West Africa Ebola outbreak triggered an increase in online activity through various social media platforms, including Twitter. Objectives: The purpose of our study was to examine characteristics of local health departments (LHDs) tweeting about Ebola, in addition to how and when LHDs were communicating Ebola-related messages. Design: All tweets sent by 287 LHDs known to be using Twitter were collected from September 3 to November 2, 2014. Twitter data were merged with the 2013 National Association of County & City Health Officials Profile study to assess LHD characteristics associated with sending Ebola-related tweets. To examine the content of Ebola tweets, we reviewed all such tweets and developed a codebook including 4 major message categories: information giving, news update, event promotion, and preparedness. A time line tracking the trends in Ebola tweets was created by aligning daily tweets with major Ebola news events posted on the Centers for Disease Control and Prevention Ebola Web site. Results: Approximately 60% (n = 174) of all LHDs using Twitter sent a total of 1648 Ebola-related tweets during the study period. Sending more tweets in general (odds ratio: 2.42; 95% confidence interval, 1.00-5.84) and employing at least 1 public information specialist (odds ratio: 2.61; 95% confidence interval, 1.14-5.95) significantly increased the odds that an LHD tweeted about Ebola. Of all the Ebola tweets collected, 78.6% were information giving, 22.5% were on preparedness, 20.8% were news updates, and 10.3% were event promotion tweets. A temporal analysis of Ebola tweets indicated 5 distinct waves, each corresponding with major Ebola news events. Conclusions: Twitter has become a communication tool frequently used by many LHDs to respond to novel outbreaks, but messaging strategies vary widely across LHDs. We recommend that LHDs increase tweet frequency during public health emergencies in order to ensure timely dissemination of critical information.

A public response to a looming health threat may be marked with misinformation and panic. However, providing the public with accurate information and updates may be an effective way to prevent widespread fear. In response to the 2014 Ebola panic in the United States, the U.S. Centers for Disease Control and Prevention (CDC) initiated a Twitter conversation with the public to alleviate concerns and provide accurate information about the disease. This study conducted a content analysis of 512 randomly selected tweets by the general public directed to the CDC. The major themes identified included the etiology of Ebola, policy, the environment, spread and scope of the disease, fear and anxiety from the public, and misinformation. Practical implications of these findings include encouraging government and emergency health response organizations to prepare educational messages and materials in advance that detail responses to common questions, such as transmission and symptoms.

BACKGROUND:The emergence of Apple's iPhone provides a platform for freelance developers to design third party apps, which greatly expands the functionality and utility of mobile devices for stress management. This study provides a basic overview of the stress management apps under the health and fitness category of the Apple App store and appraises each app's potential for influencing behavior change.METHODS:Data for this study came from a content analysis of health and fitness app descriptions available in the App Store on iTunes. Trained research assistants used the Precede-Proceed Model (PPM) as a framework to guide the coding of paid stress management apps and to evaluate each app's potential for effecting health behavior change.RESULTS:Most apps were rated as being plausible (96.9%) and intending to address stress management (98.5%), but only 63.3% were rated as recommendable to others for their use. Reinforcing apps were less common than predisposing and enabling apps. Less than one percent (0.39%) of apps included all three factors (predisposing, enabling and reinforcing).CONCLUSIONS:Practitioners should be cautious when promoting the use of stress management apps, as most provide only health-related information (predisposing) or suggestions for enabling behavior, but almost none include all three theoretical factors recommended for behavior change.

The arrival of the Zika virus in the United States caused much concern among the public because of its ease of transmission and serious consequences for pregnant women and their newborns. We conducted a text analysis to examine original tweets from the public and responses from the Centers for Disease Control and Prevention (CDC) during a live Twitter chat hosted by the CDC. Both the public and the CDC expressed concern about the spread of Zika virus, but the public showed more concern about the consequences it had for women and babies, whereas the CDC focused more on symptoms and education.

African American (AA) men are significantly more likely to die of prostate cancer (PrCA) than other racial groups, and there is a critical need to identify strategies for providing information about PrCA screening and the importance of informed decision making (IDM). To assess whether a computer-based IDM intervention for PrCA screening would be appropriate for AA men, this formative evaluation study examined their (1) PrCA risk and screening knowledge; (2) decision-making processes for PrCA screening; (3) usage of, attitudes toward, and access to interactive communication technologies (ICTs); and (4) perceptions regarding a future, novel, computer-based PrCA education intervention. A purposive convenience sample of 39 AA men aged 37 to 66 years in the Southeastern United States was recruited through faith-based organizations to participate in one of six 90-minute focus groups and complete a 45-item descriptive survey. Participants were generally knowledgeable about PrCA. However, few engaged in IDM with their doctor and few were informed about the associated risks and uncertainties of PrCA screening. Most participants used ICTs on a daily basis for various purposes including health information seeking. Most participants were open to a novel, computer-based intervention if the system was easy to use and its animated avatars were culturally appropriate. Because study participants had low exposure to IDM for PrCA, but frequently used ICTs, IDM interventions using ICTs (e.g., computers) hold promise for AA men and should be explored for feasibility and effectiveness. These interventions should aim to increase PrCA screening knowledge and stress the importance of participating in IDM with doctors.

The arrival of the Zika virus in the United States caused much concern among the public because of its ease of transmission and serious consequences for pregnant women and their newborns. We conducted a text analysis to examine original tweets from the public and responses from the Centers for Disease Control and Prevention (CDC) during a live Twitter chat hosted by the CDC. Both the public and the CDC expressed concern about the spread of Zika virus, but the public showed more concern about the consequences it had for women and babies, whereas the CDC focused more on symptoms and education. (C) 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Purpose The purpose of this study was to identify the educational needs and technological preferences of fathers of youth aged 6 to 17 years with type 1 diabetes (T1DM).Methods Participants completed 2 surveys and 1 in-person semistructured interview. Survey data were collected via Qualtrics; interviews were recorded and transcribed. The quantitative data were analyzed with SPSS 22.Results Thirty fathers/stepfathers of youth 6 to 17 years old with T1DM participated in the study. Participants reported high levels of unmet diabetes-related educational needs, including needs in fundamental areas of diabetes management such as treatment of hyperglycemia, hypoglycemia, and calculating and adjusting insulin doses. A majority of participants identified educational needs in more nuanced aspects of diabetes management, indicating a need for more information about insulin pumps and continuous glucose monitors, managing diabetes at school, and finding help for diabetes challenges. All participants used smartphone technology, and most expressed interest in receiving diabetes education via mobile technology.Conclusions The findings contribute to our understanding of the educational needs of fathers of children with T1DM and provide preliminary support for the acceptability of delivering diabetes education via mobile technology. The incorporation of patient and caregiver perspectives into the development of mHealth diabetes education applications may increase engagement and improve health outcomes.

OBJECTIVE:Although the prevalence of adolescent smoking has declined over the past two decades, the rate of decline has slowed. Electronic videogames show promise as an effective tool for health behavior change; however, the current state of tobacco prevention and cessation games has not been previously reviewed or evaluated.METHODS AND MATERIALS:Currently available tobacco-related videogames were identified through online searches and in smartphone application stores. In total, 88 games were systematically coded for characteristics, content, and quality using a reliable and valid coding instrument developed for this research.RESULTS:The majority of games included at least two components of interactivity (75.0 percent) and at least one mechanism for rewarding (69.3 percent). However, most games lacked a story line (97.7 percent) and components for sense of control (25.0 percent). There were an average of 3.54 (standard deviation = 2.20) theoretical constructs in the games, with attitudes (83.0 percent), knowledge (78.4 percent), and perceived severity (55.7 percent) being the most common. The most common educational approach used was the affective education model (83.0 percent). Most games included at least one tobacco message (90.9 percent), with a majority of messages being loss-framed (63.6 percent) and/or one-sided (75.0 percent).CONCLUSIONS:Although today's anti-tobacco videogames contain many effective features, numerous qualities and best practices for changing behaviors through games are not present. Future games should seek to address these best practices in their development and evaluation to increase the likelihood they will be effective.